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Summarises the impact of challenges of reorganization faced by the UK medical profession over a 30‐year period up to the arrival in government of New Labour in 1997 in order to provide a historical context for the appearance of clinical governance. Investigates the NHS manager as a “diplomat”, the era of “general management” and the National Health Service quasi‐market. States that: managerial supremacy has increased over a long period; managerial control over medicine seemed uncertain in 1997; and a good deal of secular change has arisen from government imposing macro‐level reorganization. Concludes that it remains to be seen whether these elements are capable of allowing the development of local clinical governance arrangements that carry the support of the medical profession.

Reports on a study which explored the views of key stakeholders regarding the meaning and implementation of effective health care and clinical governance in NHS Trusts, and the role for public health professionals. The authors used a national questionnaire survey to derive a sample for qualitative telephone interviews and two area case studies. The authors found that the meaning of effective health care and the means employed for implementation varied. Mergers were seen as hindrances to gaining organisational engagement whilst others, such as the White Paper on quality and the notion of clinical governance, were seen as facilitating. A widespread aspiration was a more integrated and corporate quality culture where quality was central, not marginal. The authors conclude that there is widespread concern among Trusts to change their culture and assert effective health care as a central value. Public health skills, rather than the discipline itself, are seen as important for such culture change.

We review 25 years of research on expatriate experiences concentrating on expatriate adjustment as a central construct, and relying on a general stressor-stress-strain framework. First, we consider who expatriates are, why their experiences differ from domestic employees, and what adjustment is. Conceptualizing (mal)adjustment in terms of stress, we next review the stressors and strains associated with it. Consolidating the wide range of antecedents (anticipatory and in-country) that have been studied to date, we note major patterns of effects and their implications for how HR managers can facilitate adjustment. Although relatively less research has focused on the consequences of adjustment, enough evidence exists to establish a bottom-line impact of poor adjustment on performance. To stimulate future efforts to understand the experiences of expatriates, we discuss the challenges and opportunities of continuing down this road of research.

With the recent publication of The Engagement Cycle (DH, 2009a), exploring the issues surrounding patient and public involvement (PPI) in World Class Commissioning, it seems timely to look at how this type of involvement/engagement has developed in recent years. Set against official rhetoric that emphasises the importance of PPI in the NHS, this paper is informed by evidence emerging from a three‐year research project into the development of practice‐based commissioning conducted at Manchester University. It is suggested that commissioners (primary care trusts and practice‐based commissioners) need to think deeply about the meaning of public involvement in their context, while at national level strategies should be flexible enough to allow a diversity of approaches which may ultimately allow PPI to flourish.

The post‐Griffiths period in the British National Health Service (NHS) has seen a major upswing of interest in the evaluation of organisational performance. Many criteria are available to conduct such an evaluation. This paper presents a coherent framework to assist in thinking about this area. It explores the definitions and usages of relevant concepts. The variety of perspectives that actors in the health care field hold about quality are also examined and the inevitable role of values highlighted.

The Local Government Act (2000) introduced new Overview and Scrutiny Committees, composed of elected non‐executive councillors, that can respond to proposals from the NHS for changes in services and also set their own agendas for more detailed scrutiny, including of the NHS. Limited capacity has meant that the focus of scrutiny has often been on statutory consultations from the NHS, service provision, NHS organisations and only occasionally on wider issues. However, it is commissioning that is officially seen as the main vehicle for shaping NHS services, so health scrutiny ought logically to address itself more to commissioning than to investigating providers. Practice‐based Commissioning (PBC) was introduced in 2004 with the aim of engaging front‐line clinicians in commissioning health care, though most such commissioning is being undertaken by groups of practices joining together to form consortia, rather than by individual GPs. In principle, this makes it more practicable for health scrutiny to include PBC, but consortia are not statutory bodies and cannot be compelled to participate. We suggest ways in which this omission might be addressed.

As it is now some time since the publication of the Health White Paper, and there is currently a pause in the progress of the Health and Social Care Bill through Parliament, it seems timely to look at how the proposed changes to patient and public involvement (PPI) may develop. This paper seeks to address these issues.

The paper examines the proposals for PPI set out in the legislation and uses the findings of the authors' recent research to examine them.

The paper argues that the legislation, as currently written, contains nothing that will guarantee a more effective engagement with either patients or the public.

This is a fast moving field at present, and the eventual outcome of this major reorganisation is unclear. This paper uses evidence from previous studies to provide an overview of the issues relating to patient and public involvement in the National Health Service and highlights the potential problems in the proposals as they stand at present.

Total purchasing in primary care (TPPC) was piloted in the mid‐1990s, first by four “pioneer sites”, and later by over 80 first and second waves of “pilot sites”. Separate evaluations of three of the pioneers show that they faced challenges similar to those experienced by the pilot sites, namely: the need to develop organisations which were effective both internally and, in their relationships with other health‐care agencies, externally; and the difficulties encountered when attempting to change the behaviour of local acute care providers. Although GP fund holding and/or TPPC have had some successes in influencing the pattern of delivery for some elective and community services, the challenge of reducing hospital admissions and lengths of stay remains formidable.

This review aims to provide an overview of the ideas, theories and research relating to the diffusion of innovations. It seeks to place the relationship between librarians and the Internet and related networked information within the context of diffusion research. It includes a brief background to diffusion research and a description of the basic model proposed by Everett M. Rogers. The theory of change agents and change agencies is discussed with the role of weak ties in the diffusion of ideas through communication networks. The implications of the need to achieve a critical mass in some applications of networked communication are outlined together with theories about critical mass. The review identifies the characteristics that make these technologies unique and discusses the implications for future research. Finally, the relevance of diffusion theory to librarians seeking to introduce new communication‐based technologies into academic departments is discussed.